Category Archives: The Empowered Patient

REAL Healthcare Reform = ObamaCare + eHealth + mHealth

ObamaCare is looked upon both positively and negatively as the end-all / be-all of Health Care Reform in the United States.  It is politically charged and subject to nationwide debate and likely repeated judicial challenge.  However, it need not be so divisive as it seems to have actually inspired and triggered other significant Healthcare reforms and Healthcare entrepreneurial advancements via legitimate Free Market Solutions, namely, “eHealth” [Electronic Health] and “mHealth” [Mobile Health].  This 4-Minute Video explains this interesting and ongoing technological development in Healthcare Reform.

 This is part of my “Two Minute Drill” Series of Healthcare Videos.  The phrase is taken from the NFL, i.e., United States Professional Football, and refers to that intense time of the last 2 minutes of the end of the 1st Half, or of the Game, when teams use a no-nonsense carefully timed 2-Minute Drill to most efficiently move down the field to score points.  With Television Commercials, the 2-Minute Drill often takes 10-15 minutes of “Real Time” and thankfully that affords me the ability to still use the phrase when my succinct Videos are sometimes 4 to 5 Minutes in length.  I hope you enjoy the Healthcare Content and that it provides you with mental stimulation and creative inspiration.

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Ingredients for Change – The “Voices” of BOTH Student College Athletes & Medical Patients

With Student Athletes at Mainstream Collegiate Athletic Programs, the time has finally come for them have a “Voice” in how their rights are established and managed.  The sad reality is that breaking new ground with their rights will be as realistic as seeking sympathy from the devil.  But given how much money they generate, the National Collegiate Athletic Association (the “NCAA”) will soon have to at least “go through the motions” of listening to them because that exercise in futility is far less expensive than implementing change.  This got me thinking to my status as a “Professional Hospital Patient” and about the Hundreds of Thousands (or even Millions) of Chronically Ill Patients around the world.  Just like the Student Athlete is the Asset by which all other collegiate sports issues revolve around, the Medical Patient Voice is the benchmark of global healthcare Patient outcomes and also the standard of healthcare Consumer expectations.  Let’s be serious for a moment: the “Patient Voice” is so much more important than that of Student Athletes because Duration of Lives, Quality of Lives and Choices in Lifestyles and Professions are directly affected by healthcare decisions, laws, mandates and “Influencers.”  Thus Patient Voices MUST BE CONSIDERED in moving forward with Global Healthcare.  After all, who else knows what it is like to be a Patient?  Who else knows if the current Patient programs and protocols in place are maximizing Patient care?  Physicians?

Let’s see about that.  A few years ago in 2000 or thereabouts, when I was considering writing my Book, “Confessions of a Professional Hospital Patient,” essentially chronicling what goes on inside a Hospital hour-by-hour from a Patient Perspective, I began discussing the idea with a Physician-colleague at the wind-down of a local chapter Board Meeting of the Crohn’s & Colitis Foundation (“CCFA”).  While I have my issues with the politics of how the CCFA is often run, I sincerely applaud their efforts at helping people like me who must somehow manage life despite the increasingly pervasive challenges posed by Crohn’s Disease. I especially appreciate the volunteers who give of their time to help me in this battle.  THAT is the most selfless act a person can ever do, i.e., to give of themselves to help others expecting nothing in return.  I wish I could say the same for this Physician but he arrogantly started to question my veracity on the subject matter of being a Hospital Patient such that I could even qualify myself as an authority or “expert” to write such a book whereas he, as a Doctor, and seemingly an inherent authority on the subject matter, was more qualified.

At that point in my life I was hospitalized over 100 times for my Crohn’s Disease so I felt I had a solid authoritative voice on the subject matter and this Physician was familiar with my struggles in this regard so I did not understand why he was challenging me in front of the entire Board of Directors of the CCFA.  So I asked him how much time he spent, on average, with a patient during a hospital visit?  He replied that he wasn’t sure but it couldn’t be more than Six (6) minutes or so due to health insurance company rules and regulations.  I nodded my head in agreement that medical professionals are severely limited by such health insurance company rules and regulations but then I asked this Physician: “What then makes you think you know what goes on with a Patient inside a Hospital the other 23 Hours and 54 Minutes of the typical day?  Don’t you think that an experienced Patient like me has just a little more first-hand knowledge on this particular matter than you do?”

Mr. Know-It-All-Physician took a deep puff of his misogynistic almost-prop-like cigar and out of the corner of his mouth dismissively answered my question but did so addressing the rest of the Board so as to make a mockery or our conversation by saying: “That’s why I rely upon my Nurses.”  His physician-colleagues smirked as he packed up his materials to leave, since the meeting was winding down and our conversation was informal, but I smiled and retorted, “Thank God for Nurses because it is their system of ‘Reporting’ which ensures Continuity of Care for Patients like myself because if we Patients had to rely upon condescending physicians like you we’d be screwed.”  The room went silent and he turned to me and stuck out his hand and said, “Good luck with that Book, son.”  From my perspective, insulting and demeaning someone and then sticking out your hand as a symbol of “let’s agree to disagree on this” is akin to sending the woman you love flowers only when you are apologizing for something.  It is a meaningless gesture intended for cosmetic purposes only.  Additionally, as I was 38 years old at the time with a Law Degree and an MBA, and this arrogant Physician was well aware of my professional qualifications and skills having been the beneficiary of them on a few occasions, I just smiled and continued packing up my stuff and felt no need to shake his hand.  That was my way of saying, “You arrogant schmuck, I feel sorry for your patients.”

In terms of more recent examples of the importance of Medical Patient Voices you need look no further than September 16, 2011, when the well-respected News Resource, “NPR,” published an article written by Scott Hensley entitled, Doctors Call For Pullback On Narcotics For Chronic Pain, which was based on the findings/opinions of THREE (3) Doctors who published an editorial on the matter this past week in the Archives of Internal MedicineInstead of using narcotics for the management of chronic pain, these evidently healthy doctors advocated talking with patients about the limits of pain relief and give alternatives to opioid drugs, such as physical therapy or yoga, their due. Yoga?  Huh?  Are these doctors from Venice, CA?  Have these doctors ever been patients besides the day they were born?  Have any of these doctors seen the fabulous movie starring William Hurt entitled, “The Doctor?” Do any of these physicians have personal experiences with chronic Fibromyalgia, Arthritis, Spine-Fusion Surgery, Constant Back Pain, numerous surgeries, immune-suppressive Diseases such as Crohn’s Disease, Lupus, Pulmonary Fibrosis, etc.?

Do they even understand that a KEY ROLE of Pain Management is for the chronically ill patient to be able to nevertheless maintain a quality of Life without having to be admitted to the Hospital for Pain Relief each and every time their pain rises to the level that a Tylenol or a Rolaids cannot help them with?  Do these short-sighted doctors realize that it is even economically prudent to permit Pain Management to function in this regard as it is less expensive to dispense and monitor the narcotics than it is to admit patients to hospitals?  Or do they have such little pride in their professionalism and are so lazy that  taking the “path of least resistance” is their solution to this problem when a few bad apples of drug addicts and/or drug dealers are spoiling a Quality of Lifeline for Hundreds of Thousands of Patients suffering with chronic pain?   Do they also not realize that their actions have such far-reacting consequences that National Chain drug stores such as Rite-Aid don’t even stock the powerful, long-lasting narcotic, Oxycontin, due to the aforementioned potential abuse situations?   I only learned of the Rite-Aid situation last week when I innocently walked into a store near my Pain Management Physician’s office seeking to fill my prescription for Oxycontin only to be essentially thrown out of their store under the presumption that I was a drug abuser or drug seller.  I felt like Leper thanks to the effects of a few spineless comments in the media made by just a few Pain Management Physicians.  These days, I guess, Patients in true need of FDA-approved Pain Relief drugs are made to feel like criminals.  What a fool I was thinking it was hooded sweatshirt when all along it was my FDA-approved prescription!

In fairness to the author of the NPR article, namely, Mr. Scott Hensley, a retort was obtained from Dr. Robert Chou, who heads the group at the American Pain Society working on guidelines for clinical practice.  Mr. Chou was then quoted as saying:

While it’s important for clinicians to be more thoughtful about who they prescribe long-term opioids to and to stop opioids when they aren’t helping or there is evidence that it is causing problems, the American Pain Society believes opioids have a role in the management of chronic non-cancer pain in carefully selected and monitored patients.

There is evidence from long-term observational studies and evidence coming from some long-term clinical trials that opioids are effective for improving pain in some patients.

For example, we do not believe that a trial of low doses of opioids should be denied to a low-risk woman in her 70′s who has severe hip arthritis, who may be able to garden and walk with decreased pain on it.

While the data on overdose deaths and abuse of opioids should concern all members of society, it does not justify an extreme blanket position of no opioids for chronic non-cancer pain.

Just so no one can accuse me of being a mere spineless “opinion,” I have been a chronic Pain Patient for over 25 years who is “dependent” on narcotic pain medications through the careful administration and watchful-eye of Pain Management Specialists for treatment Severe Crohn’s Disease which has necessitated almost Twenty (20) serious surgeries, depleted my immune system such that I now have Bronchiolitis Obliterans with Organizing Pneumonia (i.e., “BOOP”) and am in the middle of a course of Chemotherapy to treat this Life-Threatening BOOP Lung Condition as a 3-month daily dose of 60 mgs of Prednisone did not cure the BOOP and only caused a Crohn’s Disease Flare-up for which I can essentially take no medication because ALL “Anti-TNF Agent” drugs such as Humira and Cimzia are off-limits to me now since the Doctors believe my exposure to Humira and Cimzia in treating my Crohn’s Disease is why I came down with BOOP.  The resulting joint pain from the Crohn’s Disease Flare-up is so debilitating at times that without Pain Medication all I can do is lie down on a couch, cry and pray for the aforementioned mystical “Yoga” relief these spineless Pain Management Physicians are suggesting.  Maybe I am lacking special candles? Perhaps I need a different Yoga uniform?  In all seriousness, is it not torture and/or cruel and unusual punishment to withhold these drugs from me when my various painful conditions are painstakingly documented and I am seeking the medications from Board Certified Pain Management Physicians?

Lastly, the dangers of Doctors, Politicians and other people with easy access to mainstream media using Public Access forums to advocate medical policy is no more demonstrative than by the recent comments made by Republican Presidential potential Candidate Michele Bachmann on Tuesday, September 13, 2011, linking the HPV Vaccine to “mental retardation,” when she told NBC News she had heard from a woman who said her daughter “took that vaccine, that injection, and she suffered from mental retardation thereafter.”  All politics and other intentions aside, such manipulations of the Mainstream Media to affect years of scientific research is dangerous and absurd and can only lead to BAD MEDICINE.  Supposedly and scientifically, this HPV Vaccine has been proven to prevent Cervical Cancer when given to teenage girls.  Accordingly, advocating anecdotal stories that, if taken at face value, could KILL MANY WOMEN with Cervical Cancer, is no different than the aforementioned spineless physicians taking the path of least resistance with respect to Pain Management treatment when they have no scientific or personal date to back-up their claims. Oh wait, it is different.  Ms. Bachmann could be putting REAL LIVES AT STAKE!  Do people not see how dangerous this situation is and that this is the classic example of the “slippery slope” often referred to in law school   If Ms. Bachmann had relayed a “story” about, for example, Crohn’s Disease not being so pervasive and that too much of a big deal is made about it because a woman she met while touring the country told her so, I would be apoplectic.  This has to stop.

These stories are all crap and they are why Credible “Patient Voices” and Health Care Social Media (“hcsm”) platforms are more critical now than ever before.  It is why I will be participating in an interactive discussion and workshop, courtesy of WEGO Health, in the September 19, 2011 “Digital Health Coalition” being held in Philadelphia, PA, for the purposes of creating an “E-Patient Bill of Rights” for the global healthcare industry. I am looking forward to sharing my insights and to listening to those of others for only then will our healthcare system have a diversified set of Rights and Responsibilities to build upon.  Just like the Student Athlete is the Asset by which all other collegiate sports issues revolve around, Medical Patient Voices are the benchmarks of global healthcare patient outcomes and they are also the standard of healthcare consumer expectations.   I am honored to be asked to contribute to that meaningful conversation.

Healthcare Significance of Google Health’s Demise & Possible Resurrection

The words “Demise” and “Resurrection” are clear contradictions in terms just as are the phrases “Kim Kardashian” and “Reality TV Actress.”  But that is exactly what Google unexpectedly ran into with its Google Health Initiative.  What started out as a seemingly hopeful Brand Extension into the “can’t miss” social media healthcare industry, which, let’s face it, is ripe with financial and growth opportunities for a savvy, behemoth company like Google, slowly morphed into that situation in high school when you bring your unbeatable 5-man hoops squad from the local Suburban Community Center into the big city to test its mettle against pick-up teams in the playground who leave no doubt as to the street smarts required to rule the game of basketball in the city streets, where the rims have no nets and even the little guys can jam the basketball.  Even your team’s leader, the tough, rebounding 6’10” Center with soft hands and a great shot gets painfully schooled by quicker Guards who aren’t nearly as tall or as talented but they understand the “hustle” of the game.  They “get” that winning is the only thing and participating with the better players on paper is useless without understanding the lay of the concrete courts.

Google Health had no idea that the profits hidden in all mainstream healthcare ventures lie in the gross inefficiencies hidden by the Health Insurers via Oil Cartel-like business practices with assistance from regulators who also benefit in one way or another.  These secret healthcare money-making practices and companies are guarded with such deep and formidable political cover that is only rivaled by the way in which Hollywood has convinced a global audience that Kim Kardashian is even a celebrity.  I think Google Health figured this out a little too late during the “Google Health 1.0” Initiative or somewhere around the 7th pick-up game of the day when even Ken Howard would have forced his “White Shadow” basketball team to pack it in to re-tool in order to fight another day. But “Coolidge” and “Salami” would live to come back another day to teach these playground players that a true “Team” with a well-executed and practiced plan can overcome even the biggest of odds.  After all, it was a TV Show which always ended with a message.

But who would have ever thought that with all its accomplishments on the web that Google would miscalculate a “David & Goliath” competition when they are actually “the David” and some Health Insurers “the Goliath”?  Sure, there’s more to Google Health’s recent demise but conceptually I think this is what Google learned and just like Coolidge and Salami, they will be back because how many other business situations with such big upsides will they be placed in the underdog role fighting for Right in an industry such as healthcare where their success is sorely needed to change the status quo and bring about meaningful healthcare reform?  I can’t think of any unless they decide to contribute to solving our national debt crisis.

Most medical professionals believe that all healthcare-related web initiatives are doomed to fail unless clinicians or other licensed medical personnel are a visible and significant part of the plan for roll-out, development and profitability.  This would seem to be an insurmountable barrier to enter the market for a company like Google Health which provided a Patient-Dedicated Service which stored and organized Medical Records. However, with the advent of “Health Care Social Media,” or “HCSM,” as it is frequently referred to as an acronym, something unique is developing on the web with healthcare involving Patients; and Patients only.  More specifically, as I learn more about HCSM, I think Chronic Patients like me yield a great deal of Influence in these healthcare web initiatives such that when a company as large, powerful and resourceful as Google gets flustered by not factoring this into their business plan and that miscalculation jeopardizes their entire healthcare initiative, this influential role of Patients in HCSM  needs to be examined and more carefully integrated into the business plan.

The fact is that Licensed Medical Professionals cannot yet participate in HCSM on a clinical individual Patient Care basis as their Licensure Boards, no matter how skilled, can’t keep up with the speed of Social Media.  This frustrating reality is applicable no matter how well intending these Doctors and Psychologists are with respect to branching out for the sake of being accessible for their Patients, and most are that selfless with what would be even more of a drain on their most precious of limited resources,namely, time.  As a result, they would leave themselves vulnerable to too many ethical, legal and moral cases of First Impression.  The smart ones heed the warnings of their attorneys and simply use HCSM to educate their Patients about new developments that affect their Patient Care and Patient populations.  Others use HCSM strictly for marketing purposes.  But some are also prematurely talking about ROI (i.e., “Return on Investment”) with respect to HCSM and thus trying to monetize HCSM before they even understand it.  However, as Apple Computer, Inc. taught us, we need to let the wine age a bit, the market define itself, then try to monetize it.

But lest we not forget that we are mostly talking about Doctors here, so they are bound to make the same mistakes their arrogant and greedy record company executive brethren made when faced with the same apparent opportunities to which Recording Artists, and in this case, Patients, also lay claim.  Although, I sincerely hope not because the younger Doctors I have been privileged to meet in the various virtual HCSM functions I have “attended” are SO SHARP and seem SO DEDICATED to Patient Care and to realistically regulating the Health Insurers who operate within the Health Insurance Industry utilizing the same unconcerned community-minded approach as the Oil Cartels that I am doing all I can to help them play a vital role in the development and growth of HCSM (and thus the emergence and re-emergence of Patient Medical Record Organization and Storage Services like Google Health).

To understand why HCSM is strictly a Patient-Driven Medium, you need to know that the only constraint on Patients sharing information and experiences with one another in HCSM is their own respective Privacy tolerance levels.  Personally, I don’t mind the world knowing that I have the incurable and auto-immune illness, Crohn’s Disease, and as a result, I have been hospitalized over 200 times and operated on almost 20 times.  I even wrote a Book about it called “Confessions of a Professional Hospital Patient” with the hope that others could learn from me sharing my information, experiences and lessons learned as I thought THAT was the Medium to disseminate all that I had learned.  A Service like Google Health offered Patients a place to safely aggregate their medical information so that it could be accessed easily by Medical Facilities and Medical Professionals all over the world thus freeing up Chronic Patients to live their lives to the fullest and never having to worry that a skiing accident in some faraway land could wind up a medical disaster where they would have to explain their unique medical condition to Doctors who speak a different language.  Even more important, a Service like Google Health would breed confidence in this type of Chronic Patient so that he or she actually goes on that trip or relocates to another city for a great new job opportunity without fear of being separated from their medical records.

An increasing amount of Patients understand the possible, if not probable, privacy tradeoffs to sharing their information and experiences in exchange for the same about their present health problem.  When they do so, they are creating Virtual Patient “Communities” of Empowered and Informed Patients with shared illnesses, symptoms, medications, complications, side effects, etc. When these Informed Patients tap into this almost instantaneous database of empowerment and consult with their real-life Physicians, the interaction is quicker, it is less intimidating for the Patient, the Patient Care becomes more collaborative in nature, and the overall Consumer Transaction is both more efficient and cost effective.  Amazingly, not one Clinician or Licensed Medical Professional was involved with the foregoing explanation of how a Service like Google Health would help in the transformation of “Patient 1.0” into the new “Google Health Empowered & Informed Patient 2.0.”  Accordingly, while it would seem counter-intuitive that Clinicians need be present to lend authenticity to a web healthcare venture, HCSM says differently and it is this underestimation which hurt Google Health.  In essence, what Google Health lacked was a modern-day Grassroots Marketing Campaign by Patients touting how useful the Service is to Chronically Ill Patients, for example, who can now travel the world knowing that all of their medical records are in one place and they need not wait for standardized Electronic Medical Records (“EMRs”) to be adopted worldwide.  And these days, Grassroots Marketing is akin to Social Media and thus it is powered by technology so it won’t take long for other Patients to get this message and find benefits of their own in these types of Services. Then, amazingly, medical professionals will come on board because that is where their Consumer Patients are.  Remember, ROI?

Therefore, the only ones dominating the HCSM playing field are Patients sharing information and experiences with other Patients for the betterment of their own Treatment as well as for the betterment of overall Healthcare.  This Patient empowerment will have a trickle-down effect which will be the Game-Changer we have all been waiting for in healthcare.   It is not going to happen as a result of healthcare reform as our political party system won’t permit the necessary changes without the other side neutralizing the effectiveness of any positive reforms.  But there is precedent for this type of success involving counter-intuitive traditional Grassroots Marketing effectuating broad-sweeping industry changes and in all places and industries it was set by a band in the Music Industry called “The Grateful Dead.”  As a result, they are one of the top grossing concert acts of all-time and they did it “acoustically,” i.e., without Technology, just Grassroots Word-of-Mouth.   Think about the influence and power of Patients utilizing the jet stream-like growth of HCSM to publicize Services like Google Health.  For the first time in many years, healthcare would then become an industry as hip as the Mobile Phone or Computer industries and that will attract top-notch employee talent and it will strongly incentivize  Physicians and Hospitals to enter into local Provider Agreements with the demographically appropriate Patients in the Google Health-type Service.  On the face of it, it appears that by just having Patients advocating a “Google Health” type quality Service within HCSM and having that Service follow The Grateful Dead business model we Patients will help bring about the changes in healthcare we have sought for so long.   Who else but Patients should be doing this anyway?

In terms of brief background on The Grateful Dead, while other bands saw touring and playing live concerts as an expensive and never-ending personal-demon filled global road trip experience that only served to market their latest albums/CDs, The Grateful Dead turned that business model on its head and instead built up their live concerts into their primary revenue-generating vehicle.  Therefore, their investment in encouraging fans to tape concerts and share them with one another created unique commodities such that if they played 300 different concerts in a given year then they had 300 Unique Products for that year. They also redefined “Community” as not just a “Place” but more as a destination where a fan could meet other fans and partake in experiences they both enjoyed and this included the purchasing of Grateful Dead Merchandise, another huge revenue-source. The “Suits” (i.e., the record company executives who always think they know best how to market an artist’s music) were concerned that encouraging the free swapping of live Grateful Dead concerts would cannibalize Grateful Dead album/cd sales but they completely missed what was really happening.  The Grateful Dead were sharing their music with the world in effect telling fans, “Check it out.  That is what we sound like when you come to see us play Live.  Stay in touch with us and when we come to your town, tell all your  friends, then come out and watch us play.  Better yet, come along for the ride and you can experience that sound in cites all over the world and you’ll be hanging out with people just like yourself who also enjoy how they feel when they listen to our music.”  A “Suit” can’t communicate all that in a Marketing Campaign.  Only a FAN CAN DO THAT, just like only a Patient can truly promote the benefits of a Service like Google Health.

Therein lies the rub, as they say, with Google Health, because the value of that Service to Patients is almost limitless and there are various Physician Practice and Hospital Provider Integrations possible within the demographically desirable Google Health EMR-like database (but, of course, only with the Patient’s prior consent).  Therefore, Google Health needs to get its Patient-Consumers to tout its Service so that it gets picked up by the powerful HCSM “winds of change” and becomes the norm for Patients whose most effective tool against the barrage of medical paperwork, appeals, prior authorizations, submission of claims, appeal of claims, etc. is Organization.  Unfortunately, in the most recent “Patient 1.0” version of Google Health they measured their progress and charted their course by the more traditional standards, and did not invest enough time and they undervalued the use of Patients as Testimonial Marketers.  At the same time, again by utilizing the “same old, same old,” they also overestimated the acceptance of, and participation in, the Service by medical practices as if that were some touchstone of success.  Remember, HCSM is a Patient-Driven Medium so catering to the Physician crowd instead of the Patient population is like going through the Oscar “Best Actress” eligibility rules with Kim Kardasian.  There is some cosmic rationale to that conversation, and she’s gorgeous so there’s that, but unless she marries a guy named “Oscar,” she will never utter that word when discussing business and her career.  (To Ms. Kardashian’s credit, she is a VERY bright business woman who also knows this and she knows exactly who her audience is and thus who she must cater to. Services like Google Health who tap into HCSM must do the same.   Physicians and Hospitals will follow in due time.)

It took the banking industry a long time to gain widespread internet acceptance such that busy people now pay their bills on line routinely.  So now with the internet being an integral part of everyday life and HCSM being an insulated Patient-Driven movement, all a Service like Google Health has to do is re-launch with the street smarts Coolidge and Salami learned from their foray into the city playgrounds playing hoops and start a Patient Grassroots campaign run through HCSM.  Once challenged by a formidable opponent as dominate as Google, the political and regulatory hassles of hiding the aforementioned gross inefficiencies in its healthcare insurance business will outweigh the financial gain guaranteed by operating as De Facto Oil Cartels and this will make these Oil Cartel-like Health Insurers blink.  That’s why we need a company the size of “Google” to get into this industry as the Government will never be a viable player due to the ever-present potential for political influence. Once HCSM exposes these gross inefficiencies through Patent Communities and Empowered Patients, which incidentally are as closely guarded by these Health Insurer/De Facto Oil Cartels as that of the acting talents of Kim Kardashian,  that’s when Hospitals and Physicians will get fully in the Game and THEN Services like Google Health will be the NORM and our Healthcare System will be truly Reformed.

Doctor-Patient Relationship – Communication, Collaboration, Mutual Respect & Trust

Due to Health Technology and the increased focus on Consumerism in Health-care, the Doctor-Patient Relationship is changing as fast as Congressman Anthony Weiner’s explanations about his Twitter transgressions.  All jokes aside, however, this is becoming a real problem for BOTH parties as Doctors try to service (and grow) their existing Patient Populations while simultaneously deal with increasingly challenging Health Insurance Company/Payor Productivity Payment Requirements and Patients literally don’t know what to do with their sudden “Patient Empowerment” which they keep hearing about from Dr. Sanjay Gupta on CNN.  As with anything else in Life, things ALWAYS come back to BASICS.  Thus, if you focus on Simplicity and treat others the way you would want to be treated, you can’t go wrong.  But how do we do that to fortify the Doctor-Patient Relationship in a 24/7, 365-day world of Health Care Social Media (“HCSM”) in which just one negative comment by a disgruntled Patient (or one with a basic personality conflict with the Doctor) can initiate an unfair world-wide Professional Reputation attack on a Medical Professional who was just trying to do his or her job?

As an almost 30 year sufferer of the Chronic, Incurable and Auto-Immune “Crohn’s Disease,” I have  had dealings with Doctors who have possessed a broad set of great, good and bad traits such as: gifted and compassionate; poorly skilled; poor communicator; excellent but with bad bedside manners (these are usually Radiologists by the way!); arrogant; strictly business (while being  closely examined – “Michael, your Surgical Wound looks like it is healing fine but did you know that you have an outstanding balance of $249,86?”); so myopic toward their own Specialty that if an ax were lodged into my forehead and they were a Pulmonologist they would give me the “all clear;” and bad listeners.  Given this continuing eye-opening experience, I have learned that the foundation of the Doctor-Patient Relationship rests on: Communication, Collaboration, Mutual Respect and Trust.

However, this foundation is a Two-Way Street as I find the most common problem with Doctors to be their refusal, reluctance or mere forgetfulness to use their most effective diagnostic tool, i.e., LISTENING.  Often times, their failure to Listen is driven by the extraordinary Diagnostic Testing Tools at their disposal such that it is now likely that a Test Result will tell them what they think they need to know, and thus they shun all Patient expertise no matter the Disease, Duration of Disease or constructive comment from the Patient.  Doctors should know better as Patients are PEOPLE and sometimes even the most technologically advanced diagnostic test will miss something so obvious or it will pick up on something completely irrelevant such that each miss or misdiagnosis could have been quickly dismissed by the Patient.

That said, Patients have an obligation to be succinct out of Respect for the Doctor’s Available Time when they do speak, elaborate or ask questions in an unsolicited manner during a consultation or examination with a Doctor since the Doctor is up against time constraints the Patient is unaware of and as a result the Patient is only allotted a certain amount of it and therefore it must be used wisely and for that Patient’s benefit.  But when the Patient “permits” the Doctor to do his or her job, this enhances the relationship for the next interaction – whenever that will be.  This “interplay” of sorts is where the Mutual Respect notion comes into play.  As the Joe Friday character from TV’s “Dragnet” would often say or infer, “Just the Facts, ma’am.”  Patients would be wise to be mindful of that same approach during the Doctor-Patient consultation/examination.

I also think Communication, Collaboration, Mutual Respect and Trust is most solidly built when both parties are conscious of establishing “consistency” because the Doctor-Patient Relationship requires a certain “familiarity” between the two (2) to afford enough time for each to best understand the other.  Over time, this comfort with one another breeds Trust and Credibility.  [This is why changing Doctors because of changes in Health Insurance Coverage is so difficult on Patients and I think almost discriminatory against chronically ill Patients like myself who count on a long-established relationships with particular Doctors in most efficiently treating Disease flare-ups.  It is also more cost-efficient but since the Health Insurance Companies operate their businesses like Oil Cartels, they don’t care about Efficiencies of any kind for if they did we would at least see Electronic Medical Records (“EMRs”) in place YEARS AGO.]

In summary, the Doctor-Patient Relationship is Fine; it just needs to get back to Basics.  Additionally, if “nurtured” properly, this professional relationship typically gets better over time.  If it does not, however, THEN it is time for the Patient to find a new Doctor.  Conversely, when the Doctor-Patient relationship stagnates and its lack of usefulness for the Patient is NOT apparent to the Patient (and that can easily happen  for a number of innocuous reasons), the Doctor should tell the Patient that he or she would be better served by another Doctor – especially in this new Global HCSM environment in which the possibility of an almost instantaneous unfair Reputation Attack is only a Tweet or  Click away.  BTW – that’s how a Doctor should handle unfair criticism that is posted in HCSM.  If it has malicious intent, call an Attorney but if it is simply a Patient venting, just stick to certain rules, be fair to all Patients, and treat your Patients as “People” AND in the manner YOU would want to be treated if they were the Doctor and you were the Patient.